Spondylolisthesis means one of the bones in your spine, a vertebra, has slipped forward on the one below it. It sounds alarming, but most people with it DON’T need surgery.
Plenty of people have a slip on an X-ray and no pain at all. When it does hurt, exercise, staying active and easing off what aggravates it settle symptoms for most people.
Surgery is for a smaller group: people whose leg pain, numbness or weakness keeps limiting their life despite good nonsurgical care, and anyone with the emergency signs listed at the end of this page.
The two main types
- Degenerative spondylolisthesis: the common type in adults over 50, and more common in women. Wear in the discs and the small joints at the back of the spine lets one vertebra drift forward, usually low in the back. It often narrows the space around the nerves as well. The same wear can also make the spine curve sideways. See adult scoliosis
- Isthmic spondylolisthesis: starts with spondylolysis, a stress fracture in a thin bridge of bone at the back of the vertebra. It usually begins in childhood or the teenage years and most often sits at the very bottom of the spine
- Who gets the stress fracture: about 1 in 20 people have one, most without ever knowing. Young athletes who arch their back over and over are at higher risk, such as gymnasts, divers, weightlifters, football players and cricket bowlers
- Less common causes: a slip can also follow a major injury, bone disease or earlier spine surgery
What the grades mean
Your scan report may give the slip a grade, based on how far the vertebra has moved forward over the one below.
- Grade 1: less than a quarter of the way. By far the most common
- Grade 2: a quarter to half the way
- Grades 3 and 4: more than half the way. These are high-grade slips, and they’re uncommon, especially in the degenerative type
- Grade 5: the vertebra has slipped completely off the one below. This is rare
The grade describes the bone, not how much it hurts. Many people with a grade 1 or 2 slip have little or no pain.
Symptoms
- Low back pain, often worse standing, walking or arching backward, and eased by sitting or bending forward
- Tight hamstrings, the muscles at the back of the thigh, especially in teenagers with the isthmic type
- Leg ache, tingling or heaviness when you walk, easing when you sit. That’s the slip narrowing the space around the nerves, called spinal stenosis. See spinal stenosis
- Pain shooting down one leg, if a single nerve is pinched. See sciatica
- No symptoms at all. Many slips are found by chance on an X-ray taken for something else
Will it get worse?
Usually not by much.
In adults with the degenerative type, about 2 in 3 slips don’t move any further over years of follow-up. When a slip does creep forward, a bigger slip doesn’t always mean more pain.
In children and teenagers, most low-grade slips stay stable too. Doctors may repeat X-rays now and then while a young person is still growing, to check the vertebra isn’t changing position.
The grade tells you where the bone sits. Your symptoms tell you what to do about it.
What helps
- Stay active: walking, cycling and swimming keep you moving without loading the slip hard. If walking brings on leg symptoms, a stationary bike lets you lean slightly forward, which gives the nerves more room
- Strengthen your trunk and hips: exercises for the deep stomach muscles, buttocks and legs help support the lower back. A physio can choose exercises that suit your slip and your symptoms
- Ease off back-arching moves for now: backbends, heavy overhead lifting and sports that repeatedly arch the back tend to aggravate it. Most people can build back into them gradually
- For young athletes: a break from the sport that hurts, often for around 3 months, then a graded return with a physio. Some doctors add a brace. Most young athletes get back to their sport, often within 3 to 6 months
- Pain relief: anti-inflammatory painkillers help some people. Check with your pharmacist that they’re safe for you
- Injections: a steroid injection around the nerve is sometimes offered for leg pain that won’t settle. It can ease pain for a while, but it doesn’t change the slip
When surgery makes sense
- Leg pain, numbness or heaviness that keeps limiting your walking and daily life after a good trial of nonsurgical care
- Weakness in the leg or foot that’s getting worse, not better
- A high-grade or worsening slip, particularly in a young person who’s still growing
- The emergency signs below. Then it’s urgent
There are two main operations, and they’re sometimes combined.
- Decompression: the surgeon removes bone and thickened tissue that’s pressing on the nerves. A laminectomy is the usual version. See laminectomy recovery
- Fusion: the slipped vertebra is joined to the one below with screws, rods and bone graft so that level can’t move. It’s used more for isthmic slips, higher-grade slips and a spine that moves too much on X-rays taken bending forward and back. See spinal fusion recovery
- Fusion isn’t automatically better: for a mild degenerative slip with narrowing, recent trials found decompression alone did about as well as adding a fusion over several years. If you’re offered a fusion, ask why it’s needed in your case
- For some young people with a stress fracture and little or no slip, the surgeon can repair the broken bridge of bone instead of fusing the level, which keeps the movement there
The American Academy of Orthopaedic Surgeons has a clear guide to spondylolysis and spondylolisthesis in children and teenagers.
Go to the emergency department now if
These can be signs of cauda equina syndrome, where the bundle of nerves at the bottom of the spine is being squashed. It’s rare, but it needs hospital assessment the same day. Don’t wait to see if it settles.
- New trouble peeing, not being able to pee, or leaking pee or poo without knowing
- Numbness around your genitals, buttocks or inner thighs, the area that would touch a saddle
- Weakness or numbness in BOTH legs, or pain down both legs
- New problems getting an erection, or loss of feeling during sex
Get it checked if
- Your foot catches or slaps when you walk, or a leg is getting weaker
- The distance you can walk keeps getting shorter
- A child or teenager has back pain that doesn’t settle with a short break from sport
- You also have a fever, weight loss you can’t explain, or a history of cancer
A slipped vertebra sounds dramatic, but for most people it’s a slow, stable change that exercise manages well.